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CATEGORY/THEME: Dissemination and Implementation of Science
ABSTRACT BODY:
Background: Successful retention of families in intervention research is vital to the effective development of evidence-based treatments. Nevertheless, retention is a major challenge in research, particularly in studies with low-income families. Stressful life events, frequent relocation, and transportation barriers have been identified as factors contributing to attrition among low-income research populations. However, few studies have explored how child characteristics influence retention. This study examines child problem behaviors and normative development as they relate to family retention across a larger intervention study.
Methods: Data were collected from 121 Early Head Start children (M=25.05 months, SD=9.63) and their families as part of an ongoing study exploring the efficacy of a strengths-based parenting intervention for low-income, high-risk families. Child externalizing behaviors were assessed by parent-report on the Child Behavior Checklist (CBCL) or Brief Infant Toddler Social Emotional Assessment (BITSEA) as age appropriate. Difficult child behaviors were assessed by the Parenting Stress Index (PSI). Motor skills, perception, and language development were assessed by the Mullen Scales of Early Learning (MSEL) and Preschool Language Scales, 5th Ed. (PLS-5). Separate linear regression models were used to determine whether child factors at study entry predicted retention over five home visits.
Results: Demographic characteristics, including age, sex, race, and ethnicity, did not predict retention. Regression analyses indicated that families with children exhibiting more externalizing symptoms, F(108)=4.96, p<.05, and more difficult behaviors, F(120)=6.75, p<.05, completed fewer home visits. Lower percentiles of overall development on the Mullen, F(63)=5.16, p<.05, and on the PLS-5, F(55)=5.26, p<.05, also predicted decreased retention.
Conclusions: Results indicate that child externalizing behaviors and developmental abilities may meaningfully contribute to retention of low-income families. One explanation may be that child problem behaviors, such as refusal to engage or attend to tasks, could influence parents’ willingness to participate. Together, these results suggest that home visitors may improve retention by providing behavior management strategies, general positive feedback, and extra supports for children with developmental weaknesses. Future research would benefit from qualitative measures of participant-generated insight into other reasons why low-income families discontinue research participation.